Bay State Health Plan Points the Way to ObamaCare

Updated July 13, 2010 12:01 a.m. ET

Joseph Rago's article on Massachusetts health-care reform ("The Massachusetts Health-Care 'Train Wreck'," op-ed, July 7) is exactly the type of selectively misleading use of facts upon which opponents of health-care reform have been relying over the past year. Health-care reform in Massachusetts has covered 60% of the state's uninsured, has done so at roughly the cost projected before reform was enacted in 2006, and remains overwhelmingly popular with the residents of the state. The state has seen a decline in its nongroup premiums of more than 50% relative to national trends.

It is true that reform has not slowed the growth of group health-insurance premiums, which have continued to rise at exactly the same rate as in the nation as a whole. Despite Gov. Mitt Romney's claims, the Massachusetts reform was not designed to slow the growth of health-care cost growth. The reform did exactly what then-Sen. Barack Obama said it would do: It reduced the costs to individuals of purchasing insurance and dramatically expanded coverage.

The new federal reform is more ambitious than the Massachusetts reform. The Patient Protection and Affordable Care Act of 2010 includes restrictions on open enrollment periods which will limit the "gaming" of the system that has raised premiums by 1% (a tiny rise relative to the enormous reduction relative to prereform). The PPACA also includes a series of changes that represent the best thinking about how to control costs, such as an independent rate-setting board for Medicare, pilots of innovative medical reimbursement approaches, and an end to the open-ended tax subsidy to the highest cost health insurance plans in the U.S. None of these is guaranteed to slow the rate of cost growth. But each is better than doing nothing, which was the alternative.

In the end, it is impossible to control health-care costs without first bringing as many citizens as possible into our health-insurance system. The Massachusetts reform showed the way to doing so in a fiscally responsible fashion, and the PPACA built on that model. This provides the groundwork for taking the next step of slowing the inexorable rise in health-care cost growth.

Prof. Jonathan Gruber

Massachusetts Institute

of Technology

Boston

Prof. Gruber is a member of the Commonwealth Health Connector Authority Board.

Contrary to Mr. Rago's view, the reform of health care in Massachusetts has created a successful template for national reform, with 97.5% of our state's residents covered by health insurance, a rate of coverage that leads the rest of the country.

Massachusetts's solutions combine both short- and long-term strategies. In the immediate term, we have used existing law to require that insurance premiums be reasonable and not excessive in relation to the services provided. Contrary to Mr. Rago's view, we have not capped rates. Instead, we have focused intense scrutiny on the reimbursement rates and contracts between hospitals, doctors and insurance companies; and we are requiring that these companies do a better job of holding costs down. It is a new world in health care in Massachusetts; the old system of insurance companies simply passing provider costs uncontested through to the consumer is over.

Gov. Deval Patrick supports a series of mid- and longer-term market reforms that will help bring costs under control. A special commission on our health-care payment system has unanimously endorsed an overhaul that would lower costs while providing patients with more coordinated, patient-centered care. These rate review and market-reform efforts go hand-in-hand in harnessing health-care costs for Massachusetts.

Barbara Anthony

Undersecretary

Massachusetts Office of Consumer Affairs and Business Regulation

Boston

I am a double board-certified, Harvard-trained orthopedic surgeon who was in a practice in northern Massachusetts that had existed from the mid-1970s at the onset of RomneyCare. Because of concerns regarding RomneyCare, my partners and I moved our practice a few miles north to New Hampshire.

We predicted what has become the RomneyCare legacy as outlined in your editorial. Unfortunately, we can't move further north to avoid ObamaCare.

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